1932353356 NPI number — NARIMAN NIKTASH MD

Table of content: NARIMAN NIKTASH MD (NPI 1932353356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932353356 NPI number — NARIMAN NIKTASH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIKTASH
Provider First Name:
NARIMAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932353356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14690 SPRING HILL DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-799-0046
Provider Business Mailing Address Fax Number:
352-799-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5350 SPRING HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34606-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-688-8116
Provider Business Practice Location Address Fax Number:
352-686-9477
Provider Enumeration Date:
11/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME 102800 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: ME102800 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001136200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".